PURPOSE: To determine which is more effective: intratunnel or extratunnel anterior cruciate ligament soft-tissue graft fixation. A secondary purpose was to determine whether groups displayed differing relations between objective International Knee Documentation Committee (IKDC) grade and the timing of full weight bearing (FWB), jogging/running, and return to sports. The study hypotheses were that intratunnel fixation would display a greater percentage of normal or nearly normal objective IKDC grades and enable earlier FWB, return to jogging/running, and return to sports. METHODS: We performed a systematic review of prospective, Studies with Level I or II evidence published from 2000 to 2011 with at least 2 years' follow-up that used interference screw hamstring autograft fixation (intratunnel group) or button, staple, or post hamstring autograft fixation (extratunnel group) for primary anterior cruciate ligament reconstruction. We also compared IKDC grades; Tegner and Lysholm scores; instrumented anterior laxity and pivot-shift test findings; timing of FWB, jogging/running, and return to sports; and modified Coleman Methodology Scores. RESULTS: The groups showed comparable modified Coleman Methodology Scores, objective IKDC grades, Lysholm and Tegner scores, instrumented anterior laxity and pivot-shift test findings, and return-to-sports timing. The intratunnel group displayed earlier FWB and jogging/running; however, return-to-sports timing did not differ between groups. Early FWB and the percentage of patients with normal or nearly normal objective IKDC grades were directly related for the extratunnel group. CONCLUSIONS: Patients who received intratunnel fixation were released earlier to FWB and jogging/running, supporting the study hypotheses. Groups did not differ in return-to-sports timing or objective IKDC grades, not supporting the study hypotheses. Early FWB in the extratunnel group was related to a greater percentage of patients having normal or nearly normal objective IKDC grades. Return-to-sports timing and having a normal objective IKDC grade were related in both groups; however, this relation was stronger with intratunnel fixation. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.
PURPOSE: To determine which is more effective: intratunnel or extratunnel anterior cruciate ligament soft-tissue graft fixation. A secondary purpose was to determine whether groups displayed differing relations between objective International Knee Documentation Committee (IKDC) grade and the timing of full weight bearing (FWB), jogging/running, and return to sports. The study hypotheses were that intratunnel fixation would display a greater percentage of normal or nearly normal objective IKDC grades and enable earlier FWB, return to jogging/running, and return to sports. METHODS: We performed a systematic review of prospective, Studies with Level I or II evidence published from 2000 to 2011 with at least 2 years' follow-up that used interference screw hamstring autograft fixation (intratunnel group) or button, staple, or post hamstring autograft fixation (extratunnel group) for primary anterior cruciate ligament reconstruction. We also compared IKDC grades; Tegner and Lysholm scores; instrumented anterior laxity and pivot-shift test findings; timing of FWB, jogging/running, and return to sports; and modified Coleman Methodology Scores. RESULTS: The groups showed comparable modified Coleman Methodology Scores, objective IKDC grades, Lysholm and Tegner scores, instrumented anterior laxity and pivot-shift test findings, and return-to-sports timing. The intratunnel group displayed earlier FWB and jogging/running; however, return-to-sports timing did not differ between groups. Early FWB and the percentage of patients with normal or nearly normal objective IKDC grades were directly related for the extratunnel group. CONCLUSIONS:Patients who received intratunnel fixation were released earlier to FWB and jogging/running, supporting the study hypotheses. Groups did not differ in return-to-sports timing or objective IKDC grades, not supporting the study hypotheses. Early FWB in the extratunnel group was related to a greater percentage of patients having normal or nearly normal objective IKDC grades. Return-to-sports timing and having a normal objective IKDC grade were related in both groups; however, this relation was stronger with intratunnel fixation. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.
Authors: Luiz Gabriel Betoni Guglielmetti; Ricardo de Paula Leite Cury; Victor Marques de Oliveira; Osmar Pedro Arbix de Camargo; Nilson Roberto Severino; Patrícia Maria de Moraes Barros Fucs Journal: J Orthop Surg Res Date: 2014-11-19 Impact factor: 2.359
Authors: Michael J Anderson; William M Browning; Christopher E Urband; Melissa A Kluczynski; Leslie J Bisson Journal: Orthop J Sports Med Date: 2016-03-15